Nervous System. - The chief action of alcohol is on the nervous system. All portions of the nervous system are affected at once by the drug, but there seems to be a regular series of poisoning stages with well-recognized clinical signs. Thus it may be said that (a) the highest cerebral centers first show the toxic effects; (d) the motor-conducting neurons come under the effect of alcohol next; (c) the sensory centers then succumb, and (d), finally, the medullary centers of respiration and circulation are markedly involved.

In the cerebral cortex the least highly organized of the faculties are primarily modified. The last of the evolutionary developments crumble first. Thus the finer ethical sentiments and regards for the proprieties become abrogated. Judgment becomes affected and bad bargains are made; stupid jokes are thought immoderately funny. Witty sallies are indulged in, which are usually flat.

For certain individuals, particularly in some in whom inhibition is a powerful deterrent to speech and expression (for alcohol cuts off inhibition), and in others from the necessity for stimulus because of antecedent indulgences, alcohol is a powerful cerebral excitant. Under its milder influences such people are often thoroughly aroused and frequently can do their best work. Usually, however, such work, if unrevised, will show, and particularly for the genius of other than the first rank, many intellectual lapses, and it is highly doubtful if alcohol ever induces any real increase in the intellectual powers, save in the certain rare individuals mentioned.

Following or coincidental with the breaking down of the higher intellectual faculties there is a a weakening of the coordinating mechanism of motion. The fiber tracts do not react properly and irregularities of movement, in the lips in speech, in the eyes in winking and seeing (double vision), in the arms in eating or drinking, in the legs in walking, are observed.

Sensory disturbances, anesthesias, develop side by side with the other changes. An early loss of tactile impressions is apparent. The drinking man drops his cigar, or his knife or fork. His loss of muscle-sense contributes to his unsteadiness in walking, or in the movements of his arms. A general mild anesthesia contributes to the sense of well-being, since cold, fatigue, slight discomforts are no longer felt; hence one of the great attractions of this class of narcotics for all those who have painful conscious states. It affords an escape from present states of intense consciousness and is eagerly sought after. The urogenital sensory segments are late in sharing in the general anesthesia.

In profound alcoholic narcosis the medullary centers are last seriously involved, the giving out of the respiratory center being the cause of death. Thus impaired consciousness, paresis or paralysis, anesthesia and respiratory failure summarize the march of the toxic action of this drug.

Respiratory System. - Medicinal amounts deepen and accelerate respiration: large doses render the breathing slow and shallow -these effects being due to stimulation or depression of the respiratory center. The stimulation may be secondary rather than primary, due in part to its action on the stomach walls. Death from a toxic dose of alcohol usually results from paralysis of respiration. It may be noted that under toxic dosage of the drug the amount of carbonic acid exhaled is diminished.

Absorption and Elimination. - Alcohol is very rapidly absorbed and circulates in the blood. It is eliminated unchanged in small proportion to the quantity ingested, owing to the fact that the greater proportion of it is oxidized in the body. The kidneys, lungs, skin, and liver share in the excretory process. It is estimated that at least 90 per cent. is oxidized. The products of oxidation are not definitely known, but they are assumed to be acetic acid and CO2 and H1O.

Kidneys. - Alcohol increases the amount of urine formed. The causes are partly due to increased blood-flow, a slight increase in pressure, and perhaps some direct action on the epithelium. Single large doses are known to cause albuminuria, and chronic kidney changes are almost universal in chronic alcoholism. Uric acid secretion does not seem to be modified.

Temperature. - Alcohol is an antipyretic of considerable power. This action is owing largely to the cooling of the blood through dilatation of the cutaneous blood-vessels, subjecting the warm blood from the interior of the body to the cooling influence of the atmosphere, and to the cooling of the surface of the body from the evaporation of sweat. The power to resist cold is diminished by the habitual use of alcohol. The drug would be useful in stimulating warmth in a person who had been long exposed to cold, but only in a warm room. Then, by rapidly dilating the blood-vessels of the skin and allowing the blood to flow to the surface, the subject is favorably affected by the external heat, while there is less danger of congestion in some internal organ.

Metabolism. - The action of alcohol in metabolism is intricate. Its many factors have not yet been determined with accuracy. Its rapid absorption and subsequent rapid oxidation brings about an increase in the energy of combustion, and thus alcohol may up to a certain point take the place of certain food elements of the body. Neumann, Atwater, and others have almost conclusively proved that alcohol may be said to save the proteids, and temporarily take the place of carbohydrates and fats as foods. Neumann's classical experiment is worth bearing in mind in this connection. It is known that in the absence of carbohydrates and fats in the diet, the proteid elements of the body are burned in their place. This is made evident in an increase of nitrogen elimination from the urine; and conversely when surplus quantities of fats and carbohydrates are supplied the nitrogen elimination falls. This general result served as a criterion in a series of experiments in which alcohol was given in the place of fats more particularly and the results on the nitrogen elimination noted. Thus in the experiment referred to a time schedule of thirty-five days, divided in six periods, was followed out. Under a constant diet for five days a nitrogenous equilibrium was first established; then for four days the amount of fat was reduced one-half; this resulted in an immediate and steady increase in the amount of nitrogen eliminated, showing that the proteids were being used to supply the fat deficiency. At the end of this second period alcohol calorically equivalent to the omitted fat was added. After a short period the nitrogen elimination commenced to diminish and at the end of ten days had sunk to the level of the equlibrium line. At this time the full amount of fat, plus the alcohol, was resumed, and the nitrogen elimination became less than before, thus showing that the alcohol had taken the place of a certain amount of fat and spared the proteid. The experiment terminated by a resumption to former conditions when the nitrogen equlibrium was once more attained.